Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index
Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index
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DOI：
10.1001/jamacardio.2019.2589
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发表时间：
2019-09-01
期刊：
影响因子：
24
通讯作者：
Mehta, Nehal N.
中科院分区：
文献类型：
--
作者：
Elnabawi, Youssef A.;Oikonomou, Evangelos K.;Mehta, Nehal N.
银屑病是一种慢性炎症性皮肤病，与冠状动脉斑块负荷增加和心血管事件有关。银屑病的生物治疗与冠状动脉斑块的形成有良好的相关性，但目前尚不清楚这些相关性是否与冠状动脉的直接抗炎作用有关。目的采用血管周围脂肪衰减指数（FAI）研究银屑病患者生物治疗与冠状动脉炎症的关系。一种新的成像生物标志物，其通过冠状动脉计算机断层扫描血管造影术（CCTA）绘制血管周围脂肪组成的空间变化来评估冠状动脉炎症。设计、设置和参与者这项前瞻性队列研究从2013年1月1日开始进行，截至2019年3月31日，分析了在基线和1年时接受CCTA且在基线时未接受生物银屑病治疗的中重度银屑病患者的FAI变化。结果：134例患者（平均[SD]年龄51.1 [12.1]岁; 84例[62.5%]男性）中，大多数患者的心血管风险较低（10年Fragrance风险评分中位数为3% [四分位数间距为1%-7%]），有中度至重度皮肤病。在这些患者中，82例接受生物银屑病治疗（抗肿瘤坏死因子α、抗白细胞介素[IL] 12/23或抗IL-17）1年，52例未接受任何生物治疗，接受局部或光治疗（对照组）。基线时，46例患者（治疗组27例，未治疗组19例）有局灶性冠状动脉粥样硬化斑块。生物治疗与1年时FAI显著降低相关（基线时FAI中位数为-71.22 HU [四分位距（IQR），-75.85至-68.11 HU]，1年时为-76.09 HU [IQR，-80.08至-70.37 HU]; P
IMPORTANCE Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries.OBJECTIVE To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA).DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline.EXPOSURES Biologic therapy for psoriasis.MAIN OUTCOMES AND MEASURES Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status.RESULTS Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor alpha, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI -71.22 HU [interquartile range (IQR), -75.85 to -68.11 HU] at baseline vs -76.09 HU [IQR, -80.08 to -70.37 HU] at 1 year; P